改良B-Lynch缝合法在剖宫产术中应用时机的研究

The investigation on application opportunity of B-Lynch suture during cesarean section

目的探讨对于有产后出血高危因素的产妇在剖宫产术中行改良B．Lynch缝合法的应用时机及其效果。方法将100例有产后出血高危因素的产妇随机分为A、B两组，每组各50例。胎盘娩出后A组行预防性改良B．Lynch缝合法；B组经传统止血方法治疗无效或出血量超过400ml，再行改良B．Lynch缝合法；另选择同期无产后出血高危因素的择期行剖宫产术的产妇50例作为C组，观察三组产妇手术时间、术中出血量、产后2h出血量、产后出血发生率的差异，并观察术后并发症。结果A组术中出血量和产后2h出血量分别为（266．00±29．90）、（301．33±40．30）ml，明显少于B组（512．67±202．12）、（554．17±201．78）ml，差异有统计学意义（P〈0．01）。A组手术时间（33．73±2．28）min，明显少于B组（49．33±10．40）min，差异有统计学意义（P〈0．01）；产后2h出血量〉400ml的发生率A组为6％（3，50），低于B组的64％（32／50），两组比较差异有统计学意义（P〈0．01）。结论对于有产后出血高危因素的产妇在剖宫产术中预防性行改良B．Lynch缝合法比传统止血方法治疗无效时再使用的效果更好，节省手术时间、降低产后出血的发生率，无术后并发症，减轻了患者的经济负担。提高了产妇的生活质量，值得推广应用。

Objective To investigate the application opportunity and effect of B-Lynch suture in severe postpartum hemorrhage during cesarean section. Methods One hundred patients with high risk to postpartum hemorrhage were randomly divided into two groups. Group A was given with preventive treatment by B-Lynch suture after the placenta Was born. Group B was given with traditional treatment, such as kneading the uterus, pressing, ＂8＂ suture, stuffing with gauze first. B-Lynch suture was used after the failure of traditional treatment or the amount of bleeding was over 400 ml.At the same time, another 50 patients without severe postpartum hemorrhage were selected as control （group C）. Observed the difference of the amount of bleeding during different time, the operation time and complications among the three groups. Results The amount of bleeding during operation and 2 h after childbirth in group A [ （266.00 ± 29.90）, （301.33 ± 40.30） ml] were obviously less than those in group B[ （512.67 ± 202.12）, （554.17 ± 201.78）ml] （ P 〈 0.01 ）. The operation time in group A [ （ 33.73 ± 2.28 ） min] was shorter than that in group B [ （ 49.33 ± 10.40） min]（P〈0.01 ）. The incidence rate of severe postpartum hemorrhage in group A （6%, 3/50） was lower than that in group B （64%, 32/50） （P〈 0.01 ）. Every parameter in group A was similar with group C. There were no serious complications during and after operation. Conclusions The preventive use of B-Lynch suture in patients with high risk to postpartum hemorrhage attains much better effects, and depresses the incidence rate of severe postpartum hemorrhage, and also improves the living quality. B-Lynch suture should be used widely in patients with high risk to postpartum hemorrhage preventively.